MedicaidPrior AuthMedium impact
MAB2024110603
Pennsylvania Medicaid (DHS)·PA · Neurology, Family Medicine, Internal Medicine·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for migraine prevention medications, revising the step therapy guidelines to require failure of beta-blockers, antidepressants, or anticonvulsants before approval. New requirements also mandate failure of two preferred CGRP monoclonal antibodies before gepants can be prescribed for migraine prevention.
Action Required
By January 6, 2025: Update prior authorization workflows for migraine prevention medications. Ensure prescribers document therapeutic failure of at least one drug from beta-blockers, antidepressants, or anticonvulsants classes before requesting authorization. For gepants, document failure of two preferred CGRP monoclonal antibodies. Verify all migraine prevention prescriptions are written by or in consultation with neurologists or certified headache specialists. Update encounter forms and EMR templates to capture required documentation.